THIS IS IT! (FOR SUOZZI)

Your last chance to come to a fundraiser for my campaign is this Thursday, October 27th, at 6:30 p.m. at The Cove Restaurant in Glen Cove.

The suggested contribution is $250, but any amount is welcome. Buy your tickets HERE or send a check made out to Suozzi 2016, P.O. 669, Glen Cove, NY 11542.

All of your support for my campaign means the world to me. Together, we will win! I hope to see you Thursday!! Thank you.

Tom

A Night in Support of Tom Suozzi

Glen Cove, New York

Thursday, October 27, 2016 • 6:30 PM

___ I/we will attend and have enclosed my/our contribution(s) of: ___$2,700 ___$1000 ___$500 ___$250 ___ Other: $__________

___ I/we cannot attend, but have enclosed my/our contribution(s) of $__________.

Each contribution must be accompanied by a completed and signed contribution form.

Please make checks payable to Suozzi 2016 and mail along with this form to:

PO Box 669, Glen Cove, NY 11542

For compliance purposes, please complete the following (Please Print):

First Name: _______________________________________________Last Name: _____________________________________________

Address: ______________________________________________________________________________________________________

City: ____________________________________________________________________ State: __________ Zip Code: ______________

Employer’s Name: ______________________________________________________________________________________________

Occupation: _______________________________________________________________________________________________

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals

whose contributions exceed $200 in an election cycle.

Please indicate if the contribution is being made by: Check (_) Cash (_) Money Order (_) Credit Card (_)

Credit Card Number: ______________________________________________________________________ Expiration Date: ___ /____

Your Signature: ___________________________________________________________________ Date Signed: ________________

Please provide the below information so we may contact you, if necessary. This information is for internal purposes only and will not appear

in required public disclosure filings:

Telephone (Work): ____________________________________________ (Mobile): _________________________________

Facsimile: ________________________________________E-mail: ____________________________________________

Contributions or gifts to Suozzi 2016 are not tax deductible. Contributions are limited to personal funds of $2,700 per person for the primary election and $2,700 for the general election. Contributions from qualified Federal PACs are limited to $5,000 per PAC for the primary election and $5,000 for the general election. Contributions from corporations, labor organization treasury funds, national banks, foreign nationals, and federal government contractors are prohibited. All contributors must be US citizens or permanent resident aliens (green card holders).

If you have any questions, please contact (516) 801-4066.